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Hell (地獄) is a big maze-like area that is surrounded by dark orange sea.

Sabitsuki can arrive here by interacting with a guillotine in the Prison, which will teleport her to a guillotine in Hell, with her severed head in it. Once in this area, the player can not return back to the Prison.

Interacting with a dark grey, orange headed creature on the big main island will teleport the player to the Starry Pier.

There is also a small secluded island in Hell, that is accessible by falling off the Starry Pier. Once on the island, the player can interact with another dark grey creature to be teleported back to the Pier. However, if the player has killed Oreko, this creature will instead teleport Sabitsuki to another Hell island. This island contains several lying bodies and flames, and it is possible to leave this place only with the use of Arms effect or by waking up.

When the Hell is visited by Rust, there are two Fetuses wandering around on the main island.

Connecting Areas

Trivia

The guillotine might be a reference to how the Severed Head Effect is obtained in Yume Nikki.

Theories

This may be what Sabitsuki has been taught to or came to believe about what would happen to people who commit bad deeds in life.

Given that the guillotine was inside the prison, speculated to be Sabitsuki's hospital, and close by is the Machine effect, this could symbolize Sabitsuki's emotional death from being bedridden for so long, or continuously "flowing" and repeating the process.

Sabitsuki might have committed a crime which makes her feel so guilty that she imagines herself being imprisoned for it, executed, and ending up in Hell.